Ear infections are divided into acute otitis media, fluid in the ear, otitis externa and chronic otitis media, and are more common in children under five. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, determines the type of inflammation by examining the eardrum and, if needed, requests a hearing test. Most fluid in the ear clears on its own within three months; for persistent cases that affect hearing, ventilation tubes are considered.
What is an ear infection?
Ear infections are inflammations that can occur in different parts of the ear. The most common types are:
- Acute otitis media: sudden, painful, often feverish inflammation of the middle ear, behind the eardrum
- Fluid in the ear (otitis media with effusion, glue ear): painless build-up of fluid in the middle ear; it causes hearing loss
- Otitis externa: painful inflammation of the skin of the ear canal, common after swimming
- Chronic otitis media: recurrent discharge with a perforated eardrum
Why are they more common in children?
In children, the Eustachian tube, which connects the middle ear to the nasopharynx, is shorter and more horizontal, so it is easily blocked during colds. Large adenoids, nursery attendance, exposure to tobacco smoke and bottle-feeding lying down increase the risk. Otitis media is most common in children under five.
What are the symptoms?
In acute otitis media there is ear pain, fever, irritability, pulling at the ear and disturbed sleep; if the eardrum perforates, discharge comes from the ear and the pain may ease. Fluid in the ear is usually painless: responding late when called, turning the TV up, inattention and delayed speech may be the first signs.
How are they treated?
In acute otitis media, the first step is pain control. Depending on the child’s age and the severity of symptoms, antibiotics may be started or, in mild cases, a period of 48–72 hours of watchful waiting may be chosen; the decision is made at the consultation according to the appearance of the eardrum.
Most fluid in the ear clears on its own within three months; follow-up is recommended during this period. Guidelines do not recommend routine use of antibiotics, steroids, antihistamines or decongestants in this situation. If the fluid lasts more than three months, a hearing test is done and treatment is planned according to the result.
Ventilation tubes (grommets)
Ventilation tubes are considered when there is fluid in both ears for more than three months affecting hearing, or for recurrent acute otitis media with persistent fluid on examination. The fluid is drained through a small opening in the eardrum and a small tube is placed to ventilate the middle ear. The tube usually falls out on its own within 6–18 months and the eardrum closes. In children aged 4 or over who need new tubes, removing the adenoids may also be considered.
Ear infections in adults
In adults, the most common is otitis externa; the first step in treatment is ear drops. Cleaning the ears with cotton buds irritates the skin of the canal and encourages this inflammation. If an adult has long-lasting fluid in one ear only, the nasopharynx should be examined with an endoscope; other ear, nose and throat problems are on the ENT page. For chronic inflammation with a perforated eardrum and recurrent discharge, surgical repair may be considered.
Which situations are urgent?
- Swelling and redness behind the ear, with the ear pushed forwards
- Weakness on one side of the face or a drooping mouth
- A severe headache, stiff neck or confusion
- Sudden hearing loss or severe dizziness
With these signs, go to an emergency department or an ENT specialist without delay. Other ear topics in children are on the paediatric ENT page.
The surgical process
Ventilation tube placement: the fluid is drained through a small opening in the eardrum and the tube is placed.
In children, a short general anaesthetic; in adults, usually local anaesthesia.
For both ears, usually 10 to 20 minutes; adding adenoid removal makes it longer.
Discharge on the same day.
The tube usually falls out on its own within 6–18 months; the eardrum usually closes on its own.
Recovery timeline
Slight bloodstained or watery discharge may come from the ear; ear drops are given if needed.
At the first check-up, the tubes are checked to be in place and open, and hearing is checked to have improved.
Until the tube falls out, there is a check-up about every 6 months. If discharge comes from the ear, drops are used.
The eardrum is checked to have closed and fluid is checked not to have built up again.
Frequently asked questions
Does water getting into the ear cause infection?
With an intact eardrum, bath water does not cause otitis media. In people who swim often, water left in the canal can encourage otitis externa; drying the ear after swimming is enough.
Can a child with ventilation tubes swim?
Guidelines do not consider routine earplugs for bathing or swimming necessary in children with tubes. In dirty water, such as lakes, or when diving deep, protection may be recommended; this is decided at the check-up.
Can an ear infection cause permanent hearing loss?
Hearing loss from otitis media or fluid in the ear is usually temporary and improves as it heals. Repeated, long-lasting inflammation, however, can permanently damage the eardrum and middle ear; that is why persistent cases are followed up.
Are antibiotics always needed for otitis media?
No. In older children with mild symptoms, 48–72 hours of watchful waiting is an option. In children under two, with severe pain and high fever, or with discharge from the ear, antibiotics are started more often.
Are ventilation tubes permanent?
No. Tubes usually fall out on their own within 6–18 months. If they take a long time to fall out, they can be removed at a check-up if needed.
Should cotton buds be used to clean the ears?
Earwax is a natural secretion that protects the ear canal, and the canal cleans itself. Cotton buds can push wax further in and irritate the skin of the canal, encouraging inflammation. If the ear is blocked, it is cleaned at the practice.
Related treatments
Sources
- Lieberthal AS et al. The diagnosis and management of acute otitis media. Pediatrics, 2013.
- Rosenfeld RM et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology–Head and Neck Surgery, 2016.
- Rosenfeld RM et al. Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngology–Head and Neck Surgery, 2022.
- Rosenfeld RM et al. Clinical practice guideline: acute otitis externa. Otolaryngology–Head and Neck Surgery, 2014.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.